Critically Ill, Liver Cirrhosis, Ascites
Conditions
Keywords
Critically ill patients, liver cirrhosis, ascites requiring Paracentesis
Brief summary
Patients with liver cirrhosis are at risk for development of renal failure, usually after a precipitating event such as infection or bleeding. This form of renal failure has a high morbidity and mortality and may be partly caused by increased intra-abdominal pressure secondary to ascites. Recent studies have shown that paracentesis (and the resulting decreased IAP) can increase urinary output and decrease renal arterial resistive index in patients with hepatorenal syndrome (a very pronounced form of renal failure in cirrhosis patients). The aim of this study is to evaluate the influence of Paracentesis on intra-abdominal pressure and kidney function in critically ill patients with liver cirrhosis and ascites across a wider range of kidney function. Kidney function will be evaluated using several estimates of glomerular filtration rate and measures of kidney injury i.e. cystatin C, serum NGAL, creatinine clearance, urinary output and renal arterial resistive index.
Interventions
PROCEDUREparacentesis
as indicated according to the treating physician (the indication for Paracentesis is not the subject of study)
Sponsors
University Hospital, Ghent
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* \>18 y old * Admitted to the ICU * Known liver cirrhosis with ascites on clinical examination and/or ultrasound * Sedated and mechanically ventilated * Paracentesis deemed necessary by treating physician * Arterial and central venous catheter in place * Urinary catheter in place
Exclusion criteria
* Previous inclusion in the same study * Renal replacement therapy in place * Urinary catheter contra-indicated * Use of radiocontrast media within 72h before paracentesis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intra-abdominal pressure and kidney function before, during, immediately after and 12-24h after Paracentesis | 24h after paracentesis | Kidney function parameters include 2h creatinine clearance, serum and urine creatinine, renal artery resistive index (measured via color Doppler), urinary output, serum cystatine C and NGAL measurement. |
Secondary
| Measure | Time frame |
|---|---|
| The association between the change in IAP and kidney function | 24h after paracentesis |
| The relationship between the amount of fluid drained and any effect on IAP and kidney function | 24h after paracentesis |
| Cystatin C, NGAL, creatinine clearance, serum creatinine, urinary output and RI as measures of kidney injury in patients with liver cirrhosis and ascites | 24h after paracentesis |
Countries
Belgium
Outcome results
None listed